Provider Demographics
NPI:1659565679
Name:NEWPORT, BRENDA ANN
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:NEWPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:ANN
Other - Last Name:NEWPORT CPM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPM
Mailing Address - Street 1:7041 NORTHVIEW AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2742
Mailing Address - Country:US
Mailing Address - Phone:330-493-3050
Mailing Address - Fax:
Practice Address - Street 1:7041 NORTHVIEW AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-2742
Practice Address - Country:US
Practice Address - Phone:330-493-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01100019175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay